Increasing Heart Rate Over Time May Predict CV Events

Slowdowns associated with lower risk

Both a patient's resting heart rate and how it changes over time may have prognostic value with respect to predicting cardiovascular events in the long term, researchers said.

In a retrospective analysis of ARIC (Atherosclerosis Risk in Communities Study) data with a median of 3 years between measurements, each 5-bpm increase in heart rate over time was associated with:

All-cause mortality (adjusted HR 1.12 , 95% CI 1.10-1.15)

Incident heart failure (adjusted HR 1.13, 95% 1.09-1.16)

MI (adjusted HR 1.09, 95% CI 1.04-1.13)

Stroke (adjusted HR 1.06, 95% CI 1.01-1.11)

Conversely, any drop in heart rate over the years was associated with lower risk, according to Scott Solomon, MD, of Brigham and Women's Hospital in Boston, and colleagues in their study published online in JAMA Cardiology. Included were the 15,680 participants in ARIC, which boasted 28 years of total follow-up.

"These findings suggest that heart rate may be a useful and easily measured biomarker of general ill health," the authors concluded. "Our findings further support the importance of measuring resting heart rate in everyday clinical practice, and potentially with remote monitoring, as a way to identify individuals who could be at greatest risk of cardiovascular and non-cardiovascular events."

"In keeping with other published studies, our findings showed that a higher resting heart rate and a temporal increase in heart rate were associated with increased risk, but a novel finding in our study was the association of a temporal drop in heart rate over time being associated with a lower number of events," Solomon's group said. "To our knowledge, this has not been reported in any previous study."

As opposed to having a last heart rate measured at 60 bpm, the 50-60 bpm range was tied to a lower risk of all-cause mortality or incident heart failure. The 60-66 bpm range was not associated with more death risk. But with anything over that, a higher risk of all-cause mortality became apparent. Heart rates over 60 bpm did translate into an elevated risk of incident heart failure.

Solomon and colleagues noted that the most recent heart rate measurement by itself also had associations with events down the line:

Use of beta-blockers at any time neutralized the associations between heart rate or change in heart rate and all-cause mortality.

"It is not clear why beta-blocker therapy significantly interacts with the association between change in heart rate or time-updated heart rate and all-cause mortality, such that participants receiving beta-blockers no longer had a significant association between change in heart rate and all-cause mortality or time-updated heart rate and all-cause mortality," the investigators said.

"This finding is not in keeping with results in our group's previous analyses of patients with heart failure with preserved or reduced ejection fraction."

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